Primary therapy of penile cancer (carcinoma in situ/T1 tumors) consists of
circumcision, microsurgical excision, application of 5-fluorouracil cream,
radiation, or laser treatment. In cases of larger T1 tumors or T2 and dista
l T3 tumors, partial penectomy with a 2-cm margin of clearance is mandatory
.
Secondary therapy includes inguinal lymphadenectomy 4-6 weeks after primary
treatment and antibiotic prophylaxis. Independent prognostic factors for t
he presence of lymph node metastases are T stage and grading. Only patients
with noninvasive GI or G2 tumors and nonpalpable inguinal lymph nodes are
candidates for surveillance with careful follow-up. Inguinal lymphadenectom
y is performed in a radical or modified (Catalona) manner. Sentinel biopsy
(Cabanas) may regain importance with the use of gamma probes. Complication
rates of inguinal lymphadenectomy correlate to the extent of the procedure
and must be weighed against the possibility of cure with lymphadenectomy. I
n cases of inguinal lymph node metastasis, removal of the iliac lymph nodes
(one- or two-step procedure) is necessary.